本文選題：R.E.N.A.L.評分　切入點：腎腫瘤　出處：《廣西醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的：探討R. E. N. A. L.評分系統(tǒng)在局限性腎腫瘤手術(shù)治療中的作用,比較不同復(fù)雜程度的腫瘤在手術(shù)方式、臨床指標方面的區(qū)別。材料與方法：本研究回顧性分析了我院2008年9月至2014年12月期間,同一術(shù)者手術(shù)治療152例局限性腎腫瘤患者的臨床資料。使用R. E. N. A. L.評分系統(tǒng)(R. E. N. A. L. nephrometry score, RNS)對每個腎腫瘤進行量化評分,根據(jù)R. E. N. A. L.,總分(total nephrometry score, TNS)將腫瘤分為低度復(fù)雜、中度復(fù)雜和高度復(fù)雜三組；統(tǒng)計學運用非參數(shù)檢驗、ROC曲線等方法進行組間的分析與比較。結(jié)果：152例患者中,低度復(fù)雜25例(16.4%),中度復(fù)雜65例(42.8%),高度復(fù)雜62例(40.8%),中位TNS為9分(范圍4-12),中位腫瘤大小5.7 cm(范圍1.5,10.3)；行保留腎單位手術(shù)54例(35.5%),開放和腹腔鏡分別為22例和32例；行根治性腎切除術(shù)98例(64.5%),開放和腹腔鏡分別為55例和43例。低、中、高度復(fù)雜組間的首診癥狀、估計出血量和手術(shù)方式均有顯著差異(P0.001)。腫瘤復(fù)雜程度越低,無癥狀腎腫瘤越多,術(shù)中估計出血量越少。TNS與不同手術(shù)方式的選擇密切相關(guān)(P0.001),從ROC曲線的結(jié)果可知,TNS能有效預(yù)測手術(shù)方式(P≤0.007),當TNS9分(敏感度85.7%,特異度85.1%)時,可考慮行根治性腎切除術(shù)；另外,在行保留腎單位手術(shù)的患者中,當TNS8分(敏感度36.4%,特異度100%)時,可考慮行腹腔鏡保留腎單位手術(shù)。結(jié)論：RNS可以比較全面地描述腎腫瘤空間上的解剖學特征,評估腫瘤復(fù)雜程度,指導(dǎo)制定手術(shù)方案：TNS≤8分推薦行腹腔鏡保留腎單位手術(shù)；TNS≥9分推薦行根治性腎切除術(shù)。該結(jié)論可能只適用于本研究中的術(shù)者,尚需在不同中心或不同術(shù)者中比較證實。
[Abstract]:Objective: to investigate the role of R.E.N.A.L. scoring system in the surgical treatment of localized renal tumors, and to compare the surgical methods of tumors with different degrees of complexity. Materials and methods: this study retrospectively analyzed the period from September 2008 to December 2014 in our hospital. Clinical data of 152 patients with localized renal neoplasms treated by the same operation. Each renal tumor was quantified by using the R.E.N.A.A.L. nephrometry score system. According to R. E. N. A. L., total nephrometry score (TNSs), the tumors were divided into three groups: low degree complex group, moderate complex group and high complex group. There were 25 cases with low complexity, 65 cases with moderate complexity with 42.8%, 62 cases with high complexity with 40.8m, with median TNS of 9 points (range 4-12, median tumor size 5.7 cm (range 1.510. 3), 54 cases with nephron-sparing surgery, 22 cases with open surgery and 32 cases with laparoscopy, respectively. 98 cases underwent radical nephrectomy, 55 cases with open nephrectomy and 43 cases with laparoscopy. There were significant differences in the first diagnosis symptoms, estimated bleeding volume and surgical methods among the low, middle and high complex groups. The lower the tumor complexity, the more asymptomatic renal tumors. The less blood loss estimated during the operation, the more closely related to the choice of different surgical methods. From the results of the ROC curve, it can be seen that TNS can effectively predict the surgical procedure P 鈮，

本文編號：1611396